Complications
Surgery involving decompression alone, or combined with fusion, can cause dural tears that risk associated injury to the cauda equina and nerve root injuries.[180]
Vascular injuries can occur with anterior exposures. The iliolumbar veins are particularly prone when accessing the L4-5 level.
Aortic injuries have been reported after an over-zealous discectomy.
Bowel or peritoneal injuries are very rare, although they are likely to occur with transperitoneal exposures.
Retrograde ejaculation can occur as a result of damage to the autonomic nerves at L4-5 or the L5S1 levels. It is more common in the transperitoneal than the retroperitoneal approaches. In rare cases this complication is irreversible.
Adjacent-level degeneration is a known problem after short or long fusions; however, it must be recognized that degenerative changes at the adjacent levels are not always related to the fusion, but may be a part of the natural history of the disease.
ASD is characterized by disk space, foraminal, or central canal narrowing and degenerative changes in the motion segment, or even deformity, at the segment adjacent to the spinal fusion levels. These changes have a confounding effect on the use and clinical effectiveness of spinal fusion.[181][182][183][184][185] In one study, the incidence of developing ASD following spinal fusion is approximately 27.4% at approximately 6.7 years.[186]
A clinical or radiological confirmation of a lack of fusion can present with persistent pain, loss of correction, implant failure, wound problems, or may be asymptomatic.
Factors that prevent or inhibit successful spinal fusion, such as the presence of a low grade infection, excess mobility, and smoking, could lead to metal failure and a pseudarthrosis.
Degenerative disk disease in the lumbar spine leads to a loss of disk height. This leads to a loss of lumbar lordosis, with a deleterious effect on the sagittal alignment of the spinal column. Disk degeneration also leads to segmental instability, coupled with facet arthritis.
Mechanical effects of the pathology, if not suitably addressed during surgery, can lead to an inadequate lumbar lordosis.
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